Analer Morbus Crohn – frühzeitige chirurgische Intervention oder langfristige konservative Therapie?

Background:Anal manifestations are common in Crohn's disease and may have a great impact on quality of life. Typical such manifestations are skin tags, ulcerations, fissures, abscess and fistula formation, in rare instances even local malignancy.Diagnosis and Treatment:Clinical examination, if necessary under anesthesia, is the diagnostic mainstay. Whereas less severe lesions such as fissures and skin tags may primarily be treated conservatively, abscess and fistula formation generally requires surgery to prevent inflammatory progress and destruction. Adequate medical therapy is a prerequisite for surgery. Plastic repairs of the fistula may be attempted if the rectum is relatively uninvolved by Crohn's disease. A fistulotomy should only be done in simple superficial fistula. In advanced cases of severe perianal and anal inflammation and destruction, temporary diversion or permanent stoma or even proctectomy may improve the quality of life.Conclusion:The long-held dogma of surgery being but the last resort for anal Crohn's disease needs to be revised. A strategy combining optimal medical therapy and sphincter-sparing surgery may successfully treat anal manifestations of Crohn's disease and avoid progress without causing relevant functional impairment.